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Related Concept Videos

Pulmonary Embolism I: Introduction01:29

Pulmonary Embolism I: Introduction

Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...

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Cumulative elevation of aPTT predicts time to major bleeding and death in ECMO: A joint longitudinal-survival model.

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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
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Indication for ECMO predicts time to first actionable bleeding complication.

Mohsyn Imran Malik1,2, Djalal Fakim1, David Drullinksy1

  • 1Division of Cardiac Surgery, London Health Science Centre, London, ON Canada.

Indian Journal of Thoracic and Cardiovascular Surgery
|February 23, 2024
PubMed
Summary
This summary is machine-generated.

Extracorporeal membrane oxygenation (ECMO) patients face bleeding risks. ECMO indication and circuit type influence bleeding timing, necessitating tailored management strategies.

Keywords:
AnticoagulationBleedingExtracorporeal membrane oxygenationVenoarterialVenovenous

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Area of Science:

  • Critical Care Medicine
  • Cardiovascular Surgery
  • Hematology

Background:

  • Bleeding is a significant complication for patients requiring extracorporeal membrane oxygenation (ECMO).
  • Optimal anticoagulation and bleeding management strategies for ECMO patients remain under-researched.

Purpose of the Study:

  • To identify risk factors and predictors for actionable bleeding complications in ECMO patients.
  • To analyze the timing of bleeding complications in relation to ECMO indication and circuit type.

Main Methods:

  • Retrospective analysis of 255 ECMO patients from January 1996 to December 2021.
  • Utilized the Bleeding Academic Research Consortium (BARC) Score for actionable bleeding classification.
  • Employed univariate/multivariate regression and Kaplan-Meier survival analysis.

Main Results:

  • 108 out of 255 patients experienced actionable bleeding complications.
  • Predictors for bleeding included diabetes, lower precannulation hematocrit, longer support duration, warfarin use, and post-cardiotomy indication.
  • Median time to first actionable bleeding was 141.2 hours, varying significantly by ECMO indication and circuit type.

Conclusions:

  • ECMO indication and circuit type are significant predictors of the timing of first actionable bleeding complications.
  • Further research is required to develop individualized anticoagulation and bleeding management protocols based on specific ECMO parameters.